Vera Mihalic protested. ‘I’ve also done a neurological residency, and let me assure you, Dr Livingston, had there been the slightest trace of intracranial growth compressing his cerebral functions I would have picked it up. The man is a paranoid schizophrenic with homicidal tendencies.’
And you’re a tight-assed bitch who’s afraid to be called wrong, Barney thought to himself.
Avery interposed to avoid the growing disharmony among his staff.
‘Wouldn’t an empirical recheck be the best way to deal with this?’
‘Obviously,’ Barney and Vera answered almost in unison.
At eleven-thirty, while Mr Johnson held a sweating and disheveled Ken Cassidy’s hands tightly behind his back, first Professor Avery, then Dr Mihalic, then Dr Leder, and finally Barney peered at the patient’s brains through the white of his right eye. None of them could deny the presence of a tumor.
By noon Ken Cassidy had been transferred to Neurology and scheduled for surgery the following morning. Twenty-four hours later the growth was removed from his frontal lobe and within a few days the neuropathologists declared it benign.
Barney soon learned another vital lesson on the privileges of the medical hierarchy. It was Avery – in the company of the neurosurgeon – who ‘volunteered’ to convey the good news to Ken Cassidy, as he lay in his new room holding his wife’s hand.
Barney had to sneak into Ken’s room at the end of visiting hours that evening. Before he even tried to introduce himself, Cassidy smiled weakly and muttered, ‘Livingston, you ornery bastard. What the hell are you doing here?’
‘It’s the latest thing in medicine, Ken. All the hospitals are recruiting basketball players for the Bedpan League. Interested in coaching us?’
‘Sure,’ he whispered, and grinned like a man who had just had a weight taken off his mind. Or in this case a cranial tumor.
Barney went off to begin his night duty, so full of adrenaline he was able to stay awake without a drop of coffee until noon the next day.
Before condemning him to eternal silence, Vera Mihalic called him every name in the book – and quite a few that were in no book or back alley he had ever encountered.
‘Why are you so pissed off?’ he asked. ‘I mean, you don’t have to give me a Nobel Prize, but I think I at least deserve a little pat on the head for saving a guy’s life. Just what the hell did I do wrong?’
She looked daggers at him. ‘You should have come to me first.’
‘Oh, for God’s sake. I discovered it at ten and the meeting was at eleven. And besides, the diagnosis was right. Isn’t that the only thing that really matters?’
‘How did they ever allow a naive schmuck like you into the program?’ she sneered. ‘Little boy, you’d better learn that there’s a pecking order if you want to make it in this game.’
She turned on her heel and marched off before Barney could respond.
Little boy? Pecking order? Game?
Thereafter at Thursday meetings, with a skill bordering on genius, she was able to avoid addressing anything to him. The best he could hope for was a third-person mention, such as, ‘Perhaps Dr Livingston doesn’t realize …’
It was 1964 – a year for medical controversy in the outside world as well.
The doctors who served their country during World War II had come home to discover that they had to wage another battle. This time the enemy was not Hitler or Tojo but Harry S. Truman, President of the United States. He had been determined to establish a program that would offer free medical care to every member of society. The American Medical Association was up in arms. This was creeping socialism and they would fight it to the end.
The battle lasted nearly twenty years. In 1964, President Lyndon Johnson pressured Congress to pass his Medicare bill, which offered free medical care to people over sixty-five and the disabled of all ages.
His victory was all the more heroic because the AMA had spent many millions of dollars and had at least twenty-three full-time lobbyists in Washington to prevent what they viewed as an infringement upon their lives and livelihood.
Also in 1964, the Surgeon General issued his long-awaited report on the effects of smoking on health, presenting evidence linking it to lung cancer, heart disease, and various respiratory conditions – as might be expected from a product that filled the human lungs with the same kind of poison emitted by automobile exhaust pipes.
But the tobacco industry had its own scientific teams, who counterattacked with equally ‘conclusive’ proof that smoking could actually be beneficial as a ‘relaxant’ for people under pressure.
On another front, the U.S. Public Health Service charged that insecticides were killing thousands of fish in the Mississippi River and would wreak further environmental havoc if stringent controls were not immediately initiated to stop the pollution.
On a smaller but no less important front, a long-standing dispute was settled by an uneasy truce between Henry Dwyer, M.D., and his wife, Cheryl. By sheer weight of scientific evidence, sophistry – and unremitting verbal harassment – he had persuaded his wife to go on the Pill.
Cheryl wanted only to follow the dictates of her religion. But ultimately she was convinced that the latest drug Hank was proposing – containing, as it did, merely estrogen and progestogen, both related to natural hormones already found in the female endocrine system – would, in fact, come closer to obeying God’s dictates than any other precaution yet devised.
Hank was a first-year resident in Gynecology at St Damian’s back in Pittsburgh, where they were again among close friends and had two loving grandmas more than anxious to babysit.
Needless to say, he was spending more than half his nights on call at the hospital. He enjoyed the thrill of bringing new lives into the world. Holding up a baby in the bright, festive light of the operating table and announcing grandiosely – somewhat like the Lord’s M.C. – ‘Mrs Jones, you have a lovely boy/girl/set of twins …’
Many of the residents were married and detested night duty for keeping them away from their wives and children. But they always found in Hank a willing stand-in. Since they were so grateful, he did not feel obliged to tell them that the pleasure was entirely his.
For being on call gave him access to a quiet room with a bunk bed on which he could get more sleep than he did at home. (Children, unlike alarm clocks, cannot be set to sound at a specific hour.)
Moreover, he had discovered that the legend that babies are born in the early hours of the morning was, in fact, true. (No one knew exactly why, but perhaps it was connected with cortisol levels peaking at the time.) Thus he could have a midnight rendezvous with the stork – even a few of them – and then be able to creep into bed in his solitary cell for a few undisturbed hours.
He had also found that, if spoken in the right tone of voice, at the right hour of night, to the right nurse, the phrase ‘Miss –, you have a lovely ass/bosom/legs …’ could alleviate his monastic asceticism.
Most residents were constrained by the demands of their schedule to regard the hospital as their home away from home. By contrast, Hank Dwyer began to regard his home as a mere entr’acte in the true drama of his life.
As the former priest rationalized, It is better to dally than to burn.
30
Although Martin Luther King had received the Nobel Peace Prize a year earlier, by 1965 his whole philosophy was under fire from new militants in the Civil Rights movement.
In founding the Black Nationalist party, Malcolm X argued, ‘The day of nonviolent resistance is over.’ Ironically, within a few months, Malcolm himself was shot to death by a black revolutionary who regarded Malcolm himself as not violent enough.
James Baldwin had been ‘right on’ when he predicted ‘the fire next time.’
The relationship between Laura and Palmer also reached a stage of bellicosity. That it was war she had no doubt. And, for the first time since the Army had sent him to grad school, Palmer was actually wearing his uniform.
That was the way she foun
d him when she returned from one of those increasingly draining thirty-six-hour stints.
‘Oh, Palmer, are you going to a costume party – or are you dating a WAC?’
‘You may recall, Laura, from the days when we were still on vaguely civil terms, the Army Reserve commits me to meetings one night a week and one weekend a month. When I first signed up, I thought it would be a sacrifice. But, frankly, it’ll be a great relief.’
‘Screw you, Palmer.’
‘Well,’ he quipped sarcastically, ‘if you won’t, there are others who will.’
Laura sighed deeply. She was sick of this intramarital sniping.
‘Palmer, I know you’re too busy perfecting your Chinese to read the papers, but there’s a new thing called “no-fault divorce” and since we have what I diagnose as a case of marital rigor mortis, I think we should avail ourselves of it.’
‘Don’t be silly,’ he replied. ‘We’re just two willful people who happen to love each other despite the temporary bifurcation of our roads. I’m willing to wait because I think we belong together.’
‘Is that why you screw around?’
‘And you don’t? What about all those lusty young interns and residents?’
She began to cry, more out of frustration than sadness.
‘Oh God, Palmer, can’t you understand we’re working our guts out to save sick babies? That if we ever do get five minutes to lie on a bed, we use it for sleep? Can’t your lascivious brain comprehend “commitment”?’
‘Well, Laura,’ he said with a world-weary air, ‘I’m certainly not qualified to give you a lecture on hormonal impulses. But I’d have less respect for you if you weren’t at least getting a little on the side.’
He was wounding her and they both knew it.
She asked herself, Why do I put up with this?
Vera Mihalic made Barney an astonishing proposition.
The chief psychiatric resident, who for the past two months had been studiously avoiding him, inexplicably walked up at the end of morning rounds and invited him for a cup of coffee.
Anxious to mend fences, Barney readily agreed. He even offered to buy her a Danish, but instead she bought him one and insisted on paying for everything. (‘After all,’ she joked, ‘I’m in a higher income bracket than you.’)
Barney thanked her politely. Then, as they were sitting at a quiet table in the hospital cafeteria, he felt brave enough to add, ‘I thought you hated my guts, Vera.’
‘Don’t be silly, I’m in analysis. I learn to work these things out.’
‘Oh, I’m glad,’ he responded. ‘I’m looking forward to my own Training Analysis.’
At which she quickly added, ‘That still doesn’t mean I like you. It’s just that I know why I dislike you. It’s because you’re so much smarter than I am,’ she explained with a quiet candor. ‘And not only that, you relate to patients so much better. You should be proud of the progress you’ve made with some of them – especially since we always throw the hopeless cases to the junior people. I mean, we all broke our hearts for the first year, so why shouldn’t you?’
Barney smiled. ‘I know at some point I’m supposed to say thank you, but I can’t seem to fit it in anywhere. Is there some particular reason for all this flattery? Like maybe to inform me that I’m being dropped from the program?’
‘Of course not.’
‘Oh,’ Barney said, now completely at a loss as to why he had been invited to this coffee klatch. And he wasn’t helped by Vera’s next question.
‘Where do you sleep when you’re not on duty?’
Was he being led into some trap by this neurotic nexus of ambivalence?
‘I’ve got a room in the student dorm. It’s practically just for changing shirts, I’m there so little.’
‘Have you thought of an apartment?’
‘Sure. I’ve thought of the Waldorf-Astoria, too. But as one of the guys worked out, residents get paid something like thirty-four cents an hour.’
‘I mean sharing an apartment.’
‘With you?’
‘Well, actually, there were four of us – two guys and two girls. A neurosurgical resident, a pediatric resident, and a girlfriend of mine who’s working on Wall Street. But we’ve just had a vacancy. The neurosurgeon dropped out.’
‘In the middle of the semester? Why?’
‘He jumped out the window.’
‘God!’ Barney exclaimed. ‘You mean he killed himself?’
‘We’re on the fourteenth floor, Livingston – so take a guess. Anyway, your share of the rent would be twenty-seven-fifty a month, and cleaning the kitchen once a week. What do you say?’
‘Gosh, Vera, I’m flattered.’
‘Does that mean yes or no?’
‘Am I gonna have to sleep in the neurologist’s bed?’
‘Unless you want to sleep on the floor.’
‘Well, okay,’ Barney conceded, ‘as long as you change the sheets. But I still don’t understand why you asked me.’
‘I don’t either. But my shrink and I are working on it.’
One of Seth’s rotations in his Internal Medicine residency was a stint in the Oncology Ward.
Although published statistics indicated that nearly one-third of all cancer victims were being saved – salvation being defined as continuing to live five years or more – the place still seemed like a torture chamber. Those not facing an unspeakably painful death were suffering from the awful discomfort of ‘the cures.’ Radiation or chemotherapy often made them so sick that they felt they were enduring a punishment worse than death.
What made life tolerable for Seth was the fact that Judy was now second in command of the nursing staff and they could often steal time for lunch, coffee, or at least a kiss.
Mrs Alpert, a patient with incurable bone cancer, caught sight of the doctor and nurse embracing. Seth and Judy were embarrassed and apologetic. But the patient surprised them.
‘Go on, children,’ she said, smiling. ‘It gives me pleasure to know that life goes on.’
But for some, life was going on too long.
Mel Gatkowicz, a steel worker, was living – or rather dying – proof of the validity of the Surgeon General’s report. For his two packs a day had finally succeeded in giving him lung cancer, angina pectoris, and Reynaud’s disease, a circulatory malfunction that progressively diminished the blood flow to his extremities. This meant that his fingers and toes were becoming gangrenous and needed to be amputated.
By now he was too sick to smoke, too sick to eat, and growing ever more incoherent. The only things he could convey with any accuracy was the agony that none of the drugs could sufficiently alleviate.
In a controlled experiment sanctioned by the U.S. Health Department, he was treated with heroin, but even that did not end his anguish.
Seth was assisting Dr Bart Nelson when Mel’s wife, Doris, cornered him in the corridor.
‘I can’t bear to see him like this, doctor,’ she sobbed. ‘He’s in such pain. Why can’t you do something?’
Her three sons stood behind her, their own wives beside them, as a kind of Greek chorus intoning a litany of sorrow.
‘I’m afraid we’ve done all we can,’ Dr Nelson replied as compassionately as he could. ‘We’ll simply have to wait for Nature to take its course.’
‘How long will that be, doctor?’ the eldest son asked anxiously.
Nelson shrugged. ‘I honestly don’t know. He could go any time. On the other hand he’s so tough he could linger for days – maybe even a week.’
Doris now turned to plead with Seth. ‘Don’t you think it’s inhuman to see such a strong man end like this? It isn’t my Mel lying in that bed anymore. That’s not the man I was married to for thirty-five years. He wouldn’t want to go this way, I know it. Not even a dog should suffer the way he’s suffering.’
Seth nodded in agreement.
Doris turned again to Dr Nelson. ‘You know, when I leave the hospital every night I go to church. I get on my knees and I
pray, “God, take this man. He wants to go to Your arms. He never did no wrong to nobody. Why don’t You kiss him and take away the breath of life?”’
Both doctors were moved, but Nelson had seen many Doris Gatkowiczes and had built up a kind of emotional immunity.
‘I think we’re all praying for that,’ he said quietly. He patted the grieving woman on the shoulder, nodded to the sons, and set off, his eyes to the ground.
But Seth could not extricate himself from this group half-mad with pain.
Doris’s eldest son tried to comfort her. ‘It’s okay, Ma, it won’t be long.’
‘No, no, even another minute is too much. Why doesn’t God answer me? Why doesn’t He rescue him and let him die? I feel like going in there and tearing out all those tubes in his arms.’
‘Easy, Ma, easy,’ her son murmured.
‘I don’t care, I don’t care,’ she shouted. ‘I want him to stop suffering.’
The Gatkowicz family gathered around their mother as if to insulate her from the pain they all felt emanating from their father’s bed.
They hardly noticed the young physician who had stood there, a silent witness to their agony.
Seth had coordinated his schedule so that his nights ‘on’ would coincide with Judy’s. He was sitting in the on-call area, berating a fellow resident, Joel Fischer, for smoking.
‘How the heck can you do this, Joel, when every room on this floor has got proof of what you’re doing to your own body?’
‘I can’t help it, Seth, I really can’t,’ he protested. ‘Stupid as it sounds, the only thing that gives me relief from their pain is a few puffs.’
‘Okay,’ Seth said, getting up for some fresh air. ‘But I’m not going to sit here and let you take me with you to an early grave.’
As he walked into the darkened corridor Judy came up and whispered, ‘Francine’s gone down to supper. We’re alone.’
‘What about Joel?’ he said, motioning to where the young doctor was enjoying his nicotine pacifier.
‘I’ll chat with him,’ she said reassuringly. ‘What does he like to talk about?’
‘Sex,’ Seth grinned. ‘He’s going through a divorce. Tell him about all the promiscuous girls you could fix him up with.’